| National Provider Identifier [NPI]: | 1104091065 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | DEBBIE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15 PARKMAN ST |
| Street Address 2 Of The Provider | WANG 240 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021143117 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 2447 |
| Number Of Medicare Beneficiaries | 1351 |
| Total Submitted Charge Amount | 143167 |
| Total Medicare Allowed Amount | 64979.28 |
| Total Medicare Payment Amount | 52707.7 |
| Total Medicare Standardized Payment Amount | 53896.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 2447 |
| Number Of Medicare Beneficiaries With Medical Services | 1351 |
| Total Medical Submitted Charge Amount | 143167 |
| Total Medical Medicare Allowed Amount | 64979.28 |
| Total Medical Medicare Payment Amount | 52707.7 |
| Total Medical Medicare Standardized Payment Amount | 53896.91 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 404 |
| Number Of Beneficiaries Age 65 to 74 | 446 |
| Number Of Beneficiaries Age 75 to 84 | 300 |
| Number Of Beneficiaries Age Greater 84 | 201 |
| Number Of Female Beneficiaries | 1001 |
| Number Of Male Beneficiaries | 350 |
| Number Of Non Hispanic White Beneficiaries | 725 |
| Number Of Black or African American Beneficiaries | 589 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 851 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 500 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.9294 |